Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA.
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA.
Am Surg. 2024 Nov;90(11):2857-2861. doi: 10.1177/00031348241257465. Epub 2024 May 24.
Focused Assessment with Sonography in Trauma (FAST) examination is a point-of-care ultrasound study used to evaluate for abdominal hemorrhage, pneumothorax, or pericardial blood in trauma patients as an adjunct to their initial assessment. The quality of the image can be limited, and its diagnostic value is heavily dependent on operator skill. Our objective was to determine whether a standardized review process improved image quality and reduced incidence of nondiagnostic or insufficient imaging by 10% over a 6-month period. Between July 1, 2021, and March 31, 2022, we evaluated 1106 trauma activations at our level II trauma center. Two exams per practitioner per month were reviewed by an emergency medicine trained traumatologist with specialized training in point-of-care ultrasound and board certification in echocardiography. Priority was given to exams on patients with known injuries identified on other studies. If there were no exams that matched these criteria, random exams were selected. Images were reviewed for image quality, diagnostic accuracy, and labeling with counseling given to the provider if indicated. Categorical variables were compared using chi squared analysis, while continuous non-normally distributed variables were compared using the Mann-Whitney U test. A total of 305 FAST exams were reviewed (186 pre-intervention and 119 during intervention). Image quality improved from 46.3% (n = 31/65) to 79.0% (n = 94/119) ( < .01) with need for counseling falling from 63.1% (n = 41/65) pre-QI to 42.0% (n = 50/119) post-QI ( < .01). Incidence of detectable injury, BMI, ISS, and AIS body regions were consistent across the study period. This was seen in both the geriatric and non-geriatric cohorts despite a significant increase in ISS in the post-intervention geriatric patients. A FAST review program is associated with improvement in image quality and decreased need for counseling of trauma providers.
创伤重点超声评估（FAST）检查是一种床边超声研究，用于评估创伤患者的腹部出血、气胸或心包积血，作为其初始评估的辅助手段。图像质量可能会受到限制，其诊断价值在很大程度上取决于操作人员的技能。我们的目标是确定在 6 个月的时间内，是否通过标准化的审查流程可以提高图像质量并将无诊断或成像不足的发生率降低 10%。2021 年 7 月 1 日至 2022 年 3 月 31 日，我们在我们的二级创伤中心评估了 1106 例创伤激活病例。每月每位医生进行两次检查，由接受过急诊医学培训的创伤专家进行审查，该专家具有床边超声专业培训和心脏超声委员会认证。优先考虑在其他研究中已确定有已知损伤的患者的检查。如果没有符合这些标准的检查，则选择随机检查。对图像质量、诊断准确性和标记进行审查，如果有必要，向提供者提供咨询。使用卡方分析比较分类变量，使用曼-惠特尼 U 检验比较连续非正态分布变量。共审查了 305 次 FAST 检查（186 次为干预前，119 次为干预后）。图像质量从 46.3%（n=31/65）提高到 79.0%（n=94/119）（<.01），需要咨询的比例从干预前的 63.1%（n=41/65）下降到干预后的 42.0%（n=50/119）（<.01）。可检测损伤、BMI、ISS 和 AIS 身体区域的发生率在整个研究期间保持一致。这在老年和非老年患者中都可见，尽管干预后老年患者的 ISS 显著增加。FAST 审查计划与创伤提供者的图像质量提高和咨询需求减少相关。
